MEDICAID EXPANSION WOULD LOWER DEATH RATES, STUDY SAYS

Findings come as states weigh expanding coverage for poor under Affordable Care Act

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.

Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply more motivated to see doctors.

The New England Journal study reflects a recent effort by researchers to get around that problem and allow policymakers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.

“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation.

The study, conducted by researchers from Harvard’s School of Public Health, analyzed data from three states that had expanded their programs in the past decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities. The new law also expands coverage to a similar population nationally.

Researchers looked at mortality rates in those states — Arizona, Maine and New York — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Nevada, New Mexico, New Hampshire and Pennsylvania — that did not put such expansions in place.

The number of deaths for people age 20-64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states, said Dr. Benjamin Sommers, a physician and an assistant professor of health policy and economics who was an author of the study.

In the five years before the expansion, there were about 46,400 deaths per year, while in the five years after the expansion, there were about 44,900 deaths per year. During the same period, death rates in the four comparison states increased, said Sommers, who began a yearlong stint as an adviser to the federal Department of Health and Human Services after research for the study was completed, but before its publication.

When researchers adjusted the data for economic factors like income and unemployment rates, and population characteristics like age, sex and race, and then compared those numbers with neighboring states, they estimated that the Medicaid expansions were associated with a decline of 6.1 percent in deaths. That is about 2,840 per year for every 500,000 adults added.